EORTC Risk Model to Predict Progression in Patients With Non-Muscle-Invasive Bladder Cancer: Is It Safe to Use in Clinical Practice?

PURPOSE: To evaluate the validation of European Organization for Research and Treatment of Cancer (EORTC) risk tables to predict progression in Brazilian patients with non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS: Two hundred five consecutively and prospectively selected patients with NMIBC who underwent transurethral resection were analyzed during 12 years. Six parameters were analyzed: tumor grade, size, and number, pT stage, previous recurrence rate, and carcinoma-in-situ. Time to progression, risk score, and progression probabilities were calculated and compared to probabilities obtained from the EORTC model. The C index was calculated, and accuracy was analyzed for external validation. RESULTS: A total of 152 patients had complete follow-up data, 36 died, and 17 were lost to follow-up. One hundred thirty-seven patients had primary tumors and 68 had recurrent tumors. Progression to muscle-invasive disease occurred in 42 patients (20.5%). Significant characteristics related to progression were male gender, pT1 stage, lesion size ≥ 3 cm, high grade of disease, and no combined intravesical therapy. Mean time to progression was 26.9 months; the 1-year progression rate was 3.4% and the 5-year rate was 19.1%. The C index was 0.86 at 1 year and 0.78 at 5 years. For calibration, 1- and 5-year progression rates were lower than the values predicted by EORTC risk tables, mainly in high-risk groups. Although the EORTC model overestimated the short- and long-term risk of progression, an overlapping of the confidence intervals between both populations was detected. CONCLUSION: The EORTC model successfully stratified progression risks in a Brazilian cohort, although it overestimated progression rates. This scoring system is useful in predicting progression of NMIBC; however, updating new risk markers is essential to improve risk classification and prediction of progression.

Prognostic evaluation of severe sepsis and septic shock: procalcitonin clearance vs Δ Sequential Organ Failure Assessment.

PURPOSE: The purpose of the study is to compare the clearance of procalcitonin (PCT-c) in the first 24 and 48 hours of treatment of severe sepsis and septic shock with another early prognostic marker represented by the 48-hour Δ Sequential Organ Failure Assessment (SOFA). MATERIALS AND METHODS: Prospective, observational cohort study conducted in a general intensive care unit including patients with severe sepsis and septic shock. The PCT-c was determined at the diagnosis of sepsis and after 24 and 48 hours. The SOFA score was determined at the time of intensive care unit admission and after 48 hours. RESULTS: One hundred thirty adult patients with severe sepsis and septic shock were studied over an 18-month period. The 24- and 48-hour PTC-c scores were significantly higher in survivors (P < .0001). In nonsurvivors, the initial SOFA was significantly higher, and the 48-hour Δ SOFA was significantly smaller (P = .01). The area under the receiver operating characteristic curve was 0.68 for Δ SOFA and 0.76 for 24- and 48-hour PCT-c. CONCLUSIONS: The 48-hour Δ SOFA score and the clearance of 24- and 48-hour PCT are useful markers of prognosis in patients with severe sepsis and septic shock. A decrease in PCT-c in the first 24 hours of treatment should prompt the reassessment of the appropriateness and adequacy of treatment.

Relação entre proteína Ki-67 e grau de malignidade de neoplasias astrocitárias / Relatinoship between Ki-67 protein and grade of the astrocytic neoplasms

As neoplasias astrocitárias correspondem a 60 por cento dos tumores do sistema nervoso central, sendo o estudo de sua biologia molecular um importante passo para a compreensão da gênese e comportamentobiológico destas doenças. A proteína Ki-67, por sua vez, é um marcador de proliferação celular. Os objetivos deste estudo foram identificar e quantificar a proteína Ki-67 em diferentes graus de malignidade das neoplasias astrocitárias, bem como analisar suas relações com idade e sexo. Foram estudadas por imunohistoquímica a proteína Ki-67 (Clone MIB-1, DAKO) e p53 em 47 pacientes com neoplasias astrocitárias ressecadas cirurgicamente entre 1997 e 2001, classificadas previamente e revisadas quanto ao grau de malignidade, de acordo com o proposto pela Organização Mundial da Saúde (1993). Os núcleos celulares imunomarcados foram quantificados no programa Imagelab-softium pela rezão paramétrica absoluta entre os núcleos de células positivas e o número total de células tumorais sendo contadas 1000 células. O delineamento utilizado foi transversal não controlado. Para análise estatística, a variável Ki-67 foi dividida nos grupos ausente, ,5% e .5%, Ki-67 esteve presente em 37 casos (78,72%, expressando correlação com maior grau de malignidade (p<0,001) e não expressando correlação com idade ou sexo. A hipótese de maior presença de Ki-67 em neoplasias astrocitárias de maior grau de malignidade é corroborada pelos resultados deste estudo